Medicare in Texas: What to Compare Before Open Enrollment
Medicare Open Enrollment runs October 15 through December 7 each year. During that period, Medicare says people can make certain changes between Original Medicare, Medicare Advantage, and Medicare drug coverage, with approved changes generally effective January 1.
Two main ways to receive Medicare coverage
Original Medicare
Original Medicare includes Part A and Part B. Medicare says you can generally use any doctor or hospital that takes Medicare in the United States. You may add separate Part D drug coverage and may consider other supplemental coverage such as Medigap.
Medicare Advantage
Medicare Advantage is offered through Medicare-approved private plans. Network rules, prior authorization, out-of-pocket costs, and extra benefits can vary by plan.
Medigap
Medicare Supplement Insurance can help cover certain cost-sharing in Original Medicare. Medigap is not used with Medicare Advantage and has its own enrollment and eligibility considerations.
What can change during Medicare Open Enrollment?
According to Medicare.gov, October 15–December 7 is the annual period when eligible Medicare beneficiaries may be able to:
- join, drop, or switch Medicare Advantage plans;
- switch between Original Medicare and Medicare Advantage;
- join, drop, or switch Medicare drug plans when applicable.
Do not assume every change is available in every circumstance. Medicare eligibility, plan availability, effective dates, and enrollment rules are controlled by Medicare and the applicable plan.
Questions worth comparing
- Are your doctors and hospitals available under the coverage structure?
- Are your prescriptions covered and what pharmacy rules apply?
- What premiums and out-of-pocket costs could apply?
- Does the plan use referrals or prior authorization?
- How does travel or out-of-area care work?
- What changes if you switch between Original Medicare and Medicare Advantage?
- How would a Medigap decision interact with Original Medicare?
Original Medicare vs. Medicare Advantage
| Question | Original Medicare | Medicare Advantage |
|---|---|---|
| Provider access | Generally any doctor or hospital that accepts Medicare. | May use plan networks and service-area rules for non-emergency care. |
| Drug coverage | Part D can be added separately. | Most plans include Part D, but verify the exact plan. |
| Out-of-pocket limit | Original Medicare itself does not have a yearly out-of-pocket maximum for Part A/Part B services. | Plans have a yearly limit for covered Medicare services. |
| Medigap | Can be considered with Original Medicare if eligibility/rules allow. | Medigap cannot be used to cover Medicare Advantage cost-sharing. |
Official Medicare sources
- Medicare.gov — Open Enrollment
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- Medicare.gov — Medigap coverage
Important scope note
This page provides general Medicare education. Official eligibility, enrollment, plan availability, coverage rules, and plan-specific information come from Medicare.gov, 1-800-MEDICARE, and the applicable plan. This page does not establish access to or availability of any particular Medicare product.